Objective:To study the predictive value of combining alpha-feto protein (AFP) with contrast-enhanced MRI imaging features in predicting incidence of microvascular invasion (MVI) in patients with hepatocellular carcinoma.Methods:The data of 206 patients with hepatocellular carcinoma treated at Tianjin Medical University Cancer Institute and Hospital from January 2017 to April 2019 were retrospectively analyzed. There were 179 males and 27 females, with an average age of 58.7 years. The roles of preoperative MRI imaging features and clinical data on predicting the incidence of MVI in patients with hepatocellular carcinoma were evaluated by univariate and multivariate logistic regression analyses. Multivariable regression analysis was then used to plot a nomogram.Results:There were 86 patients (41.7%) with MVI positivity and 120 patients (58.3%) with MVI negativity. Multivariate logistic regression analysis showed that AFP >400 μg/L ( OR=3.318, 95% CI: 1.243-8.855, P=0.017), two-trait predictor of venous invasion (TTPVI) ( OR=13.111, 95% CI: 6.797-28.119, P<0.001), diffusion weighted imaging/T 2 weighted imaging (DWI/T 2WI) mismatch ( OR=17.233, 95% CI: 4.731-44.490, P<0.001), and rim enhancement( OR=5.665, 95% CI: 2.579-18.152, P=0.013) predicted increased risks of MVI in patients with hepatocellular carcinoma. The constructed nomogram directly predicted the risk of MVI in these patients. Conclusions:AFP>400 μg/L, TTPVI, DWI/T 2WI mismatch and rim enhancement were independent risk factors in predicting MVI in patients with hepatocellular carcinoma. This predictive model of MVI which was based on multivariate logistic regression analysis was helpful to clinicians in making individualized treatment plans for patients with hepatocellular carcinoma.

Objective:This study is to improves the understanding of adenoid cystic carcinoma (ACC) of the tracheobronchial tree by observing the multi-slice cornputed tomography (MSCT) features. Methods:The MSCT features of 19 cases with primary tra-cheobronchial ACC confirmed by histopathology were retrospectively analyzed. Results:Among the 19 cases, lesions were located in the trachea in seven cases, in the segmental and above segmental bronchi in 10 cases, in the peripheral lung in two cases. Intra-and ex-traluminal growth were observed in 15 cases (79%), whereas broad-based intraluminal lesions were exhibited in two cases (11%). Among the seven cases of tracheal ACC, the CT scans for five cases showed a notable tendency toward submucosal extension. Two cas-es manifested as a diffuse or circumferential wall thickening of the trachea, and the other three cases presented homogeneous mass fill-ing of the trachea with wall thickening. The 10 cases with bronchial ACC were manifested as intra-and extraluminal growth. Eight cas-es presented homogeneous polypoid growth toward the adjacent lumen, and seven cases presented extraluminal parts that were larger than the intraluminal parts. Among 13 contrast-enhanced examinations, three cases were without enhancement, five cases were slightly enhanced, four cases were moderately enhanced, and one case was highly enhanced. Conclusion:MSCT performances of ACC of the tracheo-bronchial tree possessed certain characteristics, such as broad-based mass, intra- and extraluminal growth, and diffuse wall thickening. CT can diagnose tumor malignancy, but the definitive diagnosis for ACC should depend on pathology.

Objective To summarize the features of multislice spiral computed tomography (MSCT) examination of gastrointestinal stromal tumors (GISTs),and investigate the relationship between predictors and risk of MSCT examination for GISTs.Methods The clinical data of 110 patients with GISTs who were admitted to the Tianjin Medical University Cancer Institute and Hospital from July 2011 to February 2014 were retrospectively analyzed.All the patients received 64-slices spiral CT (64S-SCT) or 16-slices spiral CT (16S-SCT) scan,and the data were transported to the PACS work station for multiplanar reconstruction.All the tumor samples were collected during operation and diagnosed by morphological manifestation and immunohistochemistry of tumors.Very low,low,and medium risk of GISTs were regarded as lower risk grade,and high risk of GISTs as high risk grade.The univariate analysis and multivariate analysis about features of imaging and risk were done by chi-square test and multivariate logistic regression model.Results Tumors located at the stomach in 81 cases,small intestines in 26 cases and colorectum in 3 cases.Diameter of tumors was 0.8-25.0 cm.Smaller tumors were in round or oval shape with well demarcated boundary,and larger tumors were irregular with unclear boundary.Endo-luminal growth of lessions was detected in 25 cases,duplex growth in 35 cases and extra-luminal growth in 50 cases.Enhanced CT scan showed that most of tumors in 105 patients demostrated moderate and high enhancement,heterogeneous enhancement in 74 cases,low density sacvariable necrosis area without enhancement in 60 cases and superficial,cracked-like and deep ulcer without calcification,metastasis and ascites in 23 cases.According to the features of GISTs by MSCT examination,location of tumor,diameter,shape,boundary,growth,enhancement,cystic necrosis,ulcer and metastasis were risk factors affecting risk classification of tumors by univariate analysis (x2=7.442,49.966,31.513,46.038,13.836,16.626,23.489,8.280,6.811,P ＜0.05).Diameter of tumor more than 10 cm and ulcer were independent risk factors affecting risk classification of tumors by multivariate analysis (OR =9.927,0.070 ; 95％ confidence intewal:1.888-52.180,0.012-0.398,P ＜ 0.05).Conclusion There is a characterization in the location,diameter,shape,boundary of tumor,growth,enhancement,cystic necrosis,ulcer and metastasis,and diameter of tumor more than 10cm and ulcer are independent risk factors affecting the risk classification of GISTs.

OBJECTIVETo explore the clinical features and molecular mutation of early-onset familial adenomatous polyposis(FAP) in childhood.

METHODThe clinical features, endoscopic findings, pathology and therapeutic effect of sulindac during 11 years follow-up in a child with FAP were retrospectively reviewed . Adenomatous polyposis coli (APC) gene mutation analysis was performed by PCR and first generation sequencing.

RESULTThis 6-year-old girl was admitted for intermittent bloody stool during the last one and a half years. Colonoscopy showed hundreds of polyps in the rectum and colon. Pathological examination revealed tubular adenomas with high grade dysplasia. During the follow-up period of 11 years, the child presented intermittent mucous bloody stool. Endoscopy showed the number of polyps in colon and rectum increased to thousands, and found multiple polyps in gastric fundus and body.She was treated with sulindac at the age of 13. Then the number of polyps and the grade of pathology showed a slight improvement and no carcinoma was seen on biopsy. She has not accepted surgery until now. Gene sequencing of this child revealed 5 bp deletion at codon 1,309 of exon 15 (c.3927_3931delAAAGA) of tumor suppressor gene, whereas none of her parents had the same mutation. And no polyps were found on her parents colonoscopy.

CONCLUSIONThis child with FAP had an early onset of this disease, and clinical conditions were exacerbated with age. Sulindac was partially effective in controlling size and number of polyps. The site of mutation in this case was consistent with classic FAP, and without family history, the mutation may be a sporadic one.

Adenomatous Polyposis Coli ; Biopsy ; Child ; Colonoscopy ; Female ; Gastrointestinal Hemorrhage ; Genes, APC ; Humans ; Mutation ; Polymerase Chain Reaction ; Rectum ; Retrospective Studies

Objective: To investigate the prognostic value of chest computed tomography (CT) characteristics in crizotinib-treated pa-tients with advanced non-small cell lung cancer (NSCLC). Methods: Forty-seven patients with advanced ALK-rearranged NSCLC who re-ceived crizotinib treatment from January 2014 to March 2017 were enrolled in this retrospective study. Pre-treatment CT characteris-tics were evaluated. Patients were followed up after crizotinib treatment, and the best overall response and progression-free survival (PFS) were assessed according to the Response Evaluation Criteria in Solid Tumors (RECIST version 1.1). Results: The median PFS of all patients was 10 months. There was no association between CT characteristics and response. In univariate analysis, large tumor size (P=0.009), central type (P=0.002), consolidation of surrounding lung tissue (P=0.002), pleural effusion (P=0.001), and lymphangitic carcino-matosis (P=0.019) suggested a poor prognosis. Multivariate Cox regression analysis showed that location (hazard ratio, 3.219; 95% con-fidence interval: 1.517-6.833; P=0.002) was an independent prognostic predictor. Conclusions: Pre-treatment CT characteristics are useful in predicting the PFS of crizotinib-treated patients with advanced NSCLC harboring ALK rearrangement.

To investigate the correlation between magnetic resonance imaging (MRI) features and tumor risk grade of gas-trointestinal stromal tumors (GISTs). Methods: Between September 2007 to December 2017, 54 patients who underwent MRI and were pathologically diagnosed in Tianjin Medical University Cancer Institute and Hospital were retrospectively reviewed. We analyzed MRI features including the size, location, shape, boundary, and growth pattern of the tumor; cystic necrosis; metastasis; T1WI and T2WI signal intensities; enhancement signal intensity-time (SIT) curve pattern; and average apparent diffusion coefficient (ADC) val-ues. The MRI features were compared with the tumor risk grade. Results: Of the 54 cases, 16 were of low-risk grade, 13 were of inter-mediate-risk grade, and 25 were of high-risk grade. Statistical analysis showed that tumor size, location, shape, boundary, cystic necro-sis, signal intensity, and average ADC values were correlated with tumor risk grade (P<0.05). However, tumor growth pattern, metasta-sis, and enhancement SIT curve pattern were not correlated with tumor risk grade (P>0.05). GISTs with higher aggressive features were more likely to have larger size, irregular shape, unclear boundary, cystic necrosis, heterogeneous signal intensity, and lower ADC values on MRI. Conclusions: MRI has the potential to predict the risk grade of GISTs before surgery, thereby guiding clinical manage-ment, and evaluating prognosis.

OBJECTIVETo investigate the clinicopathologic features of adult-onset autoimmune enteropathy (AIE).

METHODSA case of adult-onset AIE was described along with a literature review.

RESULTSA 41-year-old male patient was admitted for intractable diarrhea for more than three months despite of any dietary restriction or anti-inflammatory therapy. Fat globule was observed by stool examination and Sudan III staining of the stool was positive. Enteroclysis showed weak movement and few plica of small intestine, while colonoscopy appeared normal. Small bowel biopsies revealed villus atrophy and increased crypt apoptotic bodies and lymphocytic infiltration in deep crypt. Although without significant surface intro-epithelial lymphocytosis, there were a large number of monocytes, lymphocytes, plasmacytes and neutrophilic granulocytes infiltrating in the lamina propria. Morphologically, the colonic mucous was similar to the small intestine although cryptitis and crypt abscess were significant in the former. Serum IgG anti-goblet cell antibody was demonstrated by indirect immunofluorescence. Other causes of diarrhea were excluded on the base of medical history, histopathology and other accessory examinations before the diagnosis of AIE was made. The patient had a complete remission after steroid treatment without recurrence for eight months during the follow-up even after steroid withdrawal for five months.

CONCLUSIONSAIE is exceedingly rare and timely diagnosis is important for successful therapy. Histological differential diagnoses should include ulcerative colitis, celiac disease, lymphocytic colitis, etc. The final diagnosis should be based on histological examination combined with the patient history, clinical manifestation, endoscopy finding and serological testing.

Atrophy ; Biopsy ; Celiac Disease ; pathology ; Colon ; pathology ; Colonoscopy ; Diagnosis, Differential ; Diarrhea ; etiology ; Humans ; Intestinal Mucosa ; pathology ; Intestine, Small ; pathology ; Lymphocytes ; Lymphocytosis ; pathology ; Polyendocrinopathies, Autoimmune ; pathology

Objective To evaluate the sensitivity and specificity of immunohistochemical ( IHC) staining of DNA mismatch repair ( MMR ) protein for the screening of microsatellite instability ( MSI ) colorectal cancer (CRC).Methods A total of 255 CRC cases were studied, including 140 cases of routine paraffin-embedded tissue samples and 115 cases constructed on tissue microarray .Expressions of 4 MMR proteins including MHL1, MSH2, MSH6 and PMS2 were investigated by IHC.Negative protein expression was defined as complete absence of nuclear staining within tumor cells in the presence of positively labeled internal non-neoplastic cells.Focal staining was defined as the presence of staining in <5% of the tumor cells.CRCs showing negative staining for any MMR proteins were interpreted as MMR deficient tumors . PCR-genescan MSI analysis was performed in each case by a five marker panel including Bat 26, Bat25, NR-21, NR-24 and MONO-27.Results Among the 140 CRCs with routine formalin-fixed paraffin embedded tissue sections , concordance rate between IHC and PCR-genescan was 98.6% ( 138/140 ) , the sensitivity and specificity of IHC in detecting MSI tumors were 94.9% ( 37/39 ) and 100.0% ( 101/101 ) , respectively.The 2 disconcordant cases showed focal staining in at least one of the MMR proteins but were confirmed to be MSI-H CRCs by PCR-genescan assay.On tissue microarray, 91.3% (105/115) of the cases had informative results . The concordance rate between IHC and PCR-genescan was 100.0%(105/105).Both the specificity and sensitivity of IHC in detecting MSI tumors on available tissue microarray samples were 100.0%.Ten cases were inclusive due to the presence of negative stains of MMR proteins in both the tumor and internal control cells .Conclusions Detection of 4 MMR proteins expression by IHC is reliable for identifying MSI CRCs and is recommended for routine practice .Tumors with focal MMR protein staining are highly suspected for the presence of MSI-H and PCR-genescan based MSI analysis should be performed to confirm .

Objective:To investigate the value of histological evaluation in predicting endoscopic relapse among patients with ulcerative colitis (UC) who were in endoscopic remission, and to compare the usefulness of various histological scoring systems.Methods:Histological sections from 61 patients with UC who were in endoscopic remission were retrospectively analyzed, at Peking University Third Hospital, Beijing, China from January 2015 to June 2021. They were subdivided into endoscopic persistent remission group (remission group, n=31, Mayo endoscopic score 0) and endoscopic relapse group (relapse group, n=30, Mayo endoscopic score≥1) according to the results of the first endoscopic reexamination after the biopsy. Histological evaluation was performed using the Geboes score (GS) and its simplified version (SGS), the Nancy index (NI) and the Robarts histopathological index (RHI). The median and maximum histological scores for each case in all biopsies were recorded. Univariate comparisons were performed using chi-squares and multivariate analysis using binary logistic regression. The values of four histological evaluation systems for predicting endoscopic relapse among UC patients in endoscopic remission were analyzed using receiver operating characteristic (ROC) curves. Results:Significant differences were observed between the remission and relapse groups. The differences were more pronounced in the maximum histological scores; the mean and highest results of area under the ROC curve scores (AUC) for GS, SGS, NI, and RHI were 0.657, 0.668, 0.682, 0.691, and 0.866, 0.863, 0.864, 0.869, respectively. The differences were statistically significant ( P<0.05). The corresponding best cut-offs were GS≥2B.1, SGS≥2B.1, NI≥2, and RHI≥2.5, respectively, which meant mild active inflammation histologically, while there was no statistical difference of AUC among the four histological scoring indices ( P>0.05). Univariate and multivariate analyses revealed statistically significant differences in the number of neutrophils in the epithelium and lamina propria ( P<0.05). Conclusions:Biopsies from UC patients in endoscopic remission may still have histological active inflammation which appears to correlate with endoscopic relapse. Four commonly used histological scoring systems can be used to assess the risk of endoscopic relapse among UC patients in endoscopic remission. The patients who more likely have endoscopic relapse seem to have a histological score greater than the cut-off value (i.e., mild histological activity). The maximum histological scores can accurately predict the risk of endoscopic relapse, while the presence of epithelial and laminar propria neutrophil infiltrates can independently predict the endoscopic relapse in these patients. Considering the utility and convenience in routine practice, NI is recommended for evaluating histological inflammatory activity.

OBJECTIVETo evaluate the sensitivity and specificity of immunohistochemical (IHC) staining of DNA mismatch repair (MMR) protein for the screening of microsatellite instability (MSI) colorectal cancer (CRC).

METHODSA total of 255 CRC cases were studied, including 140 cases of routine paraffin-embedded tissue samples and 115 cases constructed on tissue microarray. Expressions of 4 MMR proteins including MHL1, MSH2, MSH6 and PMS2 were investigated by IHC. Negative protein expression was defined as complete absence of nuclear staining within tumor cells in the presence of positively labeled internal non-neoplastic cells. Focal staining was defined as the presence of staining in < 5% of the tumor cells. CRCs showing negative staining for any MMR proteins were interpreted as MMR deficient tumors. PCR-genescan MSI analysis was performed in each case by a five marker panel including Bat26, Bat25, NR-21, NR-24 and MONO-27.

RESULTSAmong the 140 CRCs with routine formalin-fixed paraffin embedded tissue sections, concordance rate between IHC and PCR-genescan was 98.6% (138/140), the sensitivity and specificity of IHC in detecting MSI tumors were 94.9% (37/39) and 100.0% (101/101), respectively. The 2 disconcordant cases showed focal staining in at least one of the MMR proteins but were confirmed to be MSI-H CRCs by PCR-genescan assay. On tissue microarray, 91.3% (105/115) of the cases had informative results. The concordance rate between IHC and PCR-genescan was 100.0% (105/105). Both the specificity and sensitivity of IHC in detecting MSI tumors on available tissue microarray samples were 100.0%. Ten cases were inclusive due to the presence of negative stains of MMR proteins in both the tumor and internal control cells.

CONCLUSIONSDetection of 4 MMR proteins expression by IHC is reliable for identifying MSI CRCs and is recommended for routine practice. Tumors with focal MMR protein staining are highly suspected for the presence of MSI-H and PCR-genescan based MSI analysis should be performed to confirm.

Colorectal Neoplasms ; genetics ; DNA Mismatch Repair ; DNA-Binding Proteins ; deficiency ; genetics ; Humans ; Immunohistochemistry ; Microsatellite Instability ; Polymerase Chain Reaction ; Sensitivity and Specificity